胫骨平台骨折术后感染危险因素与TGF-β1/Smad4和Th17/Treg水平  

Risk factors of infection after tibial plateau fracture surgery and levels of TGF-β1/Smad4 and Th17/Treg

作　　者：贾建国 朱立帆 沈鹏程 李勇 杨森 JIA Jian-guo;ZHU Li-fan;SHEN Peng-cheng;LI Yong;YANG Sen(Suzhou Ninth People's Hospital,Suzhou,Jiangsu 215200,China)

机构地区：[1]苏州市第九人民医院骨科,江苏苏州215200

出　　处：《中华医院感染学杂志》2023年第11期1685-1689,共5页Chinese Journal of Nosocomiology

基　　金：江苏省科技发展计划(民生科技)基金资助项目(SS202090)。

摘　　要：目的分析胫骨平台骨折术后感染危险因素及转化生长因子-β1(TGF-β1)/果蝇抗生物皮肤生长因子蛋白4(Smad4)信号通路及辅助性T细胞17(Th17)/调节性T细胞(Treg)水平的变化。方法回顾性分析2017年3月-2022年3月苏州市第九人民医院收治的102例胫骨平台骨折术后切口红肿、渗出患者临床资料,根据切口渗出物病原菌培养情况分为感染组35例与未感染组67例,记录切口渗出物病原菌情况,采用非条件Logistic回归分析评估影响胫骨平台骨折术后切口感染的危险因素;在患者出现红肿等感染征象时采集次日空腹外周静脉血,比较两组外周血TGF-β1、Smad4、Smad7表达水平及Th17、Treg、Th17/Treg比值。结果102例胫骨平台骨折术后切口红肿、渗出患者检出病原菌阳性35例,共检出44株病原菌,其中革兰阳性菌28株占63.64%,革兰阴性菌16株占36.36%;非条件Logistic回归分析显示,植骨材料为人工骨及并发骨筋膜室综合征为胫骨平台骨折术后切口感染的危险因素(OR=2.487,2.428,P均<0.05);感染组外周血TGF-β1、Smad4 mRNA相对表达水平及Th17水平、Th17/Treg比值高于未感染组(P<0.05),Smad7 mRNA相对表达水平及Treg水平低于未感染组(P<0.05)。结论革兰阳性菌为胫骨平台骨折术后切口感染的主要致病菌,植骨材料为人工骨及并发骨筋膜室综合征是感染的高危因素,TGF-β1/Smad4信号被激活及Th17/Treg平衡被打破可能参与了感染的发生机制。OBJECTIVE To investigate the risk factors of infection after tibial plateau fracture surgery and the changes of transforming growth factor-β1(TGF-β1)/Drosophila similar to mothers against decapentaplegic(Smad)signaling pathway and helper T cell 17(Th17)/regulatory T cell(Treg).METHODS The clinical data of 102 patients with incision redness,swelling and exudation after tibial plateau fracture surgery admitted to Suzhou Ninth People's Hospital between Mar.2017 and Mar.2022 were retrospectively analyzed,the patients were divided into 35 cases in the infection group and 67 cases in the non-infection group according to the culture of pathogenic bacteria in incision exudates.The distribution status of pathogenic bacteria in incision exudates were recorded,and unconditional Logistic regression analysis was adopted to evaluate the risk factors for incision infection after tibial plateau fracture surgery.Fasting peripheral venous blood was collected on the following day when the patients showed signs of infection such as redness and swelling,and the expression levels of peripheral blood TGF-β1,Smad4 and Smad7,levels of Th17 and Treg and Th17/Treg ratio were compared between the two groups.RESULTS Among the 102 patients with incision redness,swelling and exudation after tibial plateau fracture surgery,35 cases of patients with exudation were detected positive for pathogenic bacteria,and a total of 44 strains of pathogenic bacteria were detected,of which 28 cases strains of Gram-positive bacteria accounted for 63.64%,16 strains of Gram-negative bacteria accounted for 36.36%.Unconditional Logistic regression analysis showed that bone graft material of artificial bone and presence of osteofascial compartment syndrome were the risk factors for the postoperative incision infection after tibial plateau fracture surgery(OR=2.487,2.428,P<0.05).The mRNA relative expression levels of peripheral blood TGF-β1 and Smad4,level of Th17 and Th17/Treg ratio in the infection group were higher than those in the non-infection group(P<0.05

关 键 词：胫骨平台骨折 术后感染 病原菌 危险因素 果蝇抗生物皮肤生长因子蛋白家族 转化生长因子-β1 辅助性T细胞17 调节性T细胞 

分 类 号：R619.3[医药卫生—外科学]